摘要:

ABSTRACTBackgroundThe simplest, most effective, and least expensiveHelicobacter pyloritherapy remains to be determined. Two weeks of 30 mg lansoprazole bid, 1 gm amoxicillin bid, and 500 mg clarithromycin bid (LAC2) had been shown to be an effective therapy forH. pylori.The aim of this study was to assess whether 1 week of this regimen (LAC1) would have a similar efficacy.Materials and Methods.H. pylori‐positive patients assessed histologically, by rapid urease test, microbiologically, and by a13C‐urea breath test (13C‐UBT) were randomized to receive either LAC1 or LAC2 in a single‐center open study. Patients were interviewed 1 to 3 days after completion of therapy to evaluate adverse events and compliance. Efficacy was determined by13C‐UBT at least 4 weeks after antibiotic therapy.Results.Seventy evaluable patients were randomized to receive LAC1 (n = 33) and LAC2 (n = 37). Of the 33 LAC1 patients, 30 (91%) were treated successfully (95% confidence interval (CI) = 76–98%), compared with 32 of 37 (86%) in the LAC2 group (95% CI = 71–96%). There was no difference in efficacy between the two groups (Fisher's exact testp= 1.0; 95% CI =–10.3%–19.2%). Patients taking LAC1 experienced significantly fewer severe adverse events than those taking LAC2 (Mann‐Whitney U test). One of 64 patients had primary resistance to clarithromycin, and treatment was unsuccessful in this case. Six of the 7 remaining treatment failures developed secondary resistance to clarithromycin.Conclusions.LAC1 is as effective as LAC2 and is associated with less toxicity. Posttreatment clarithromycin resistance is common in patients who do not experience s

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00012.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.The incidence of gastric non‐Hodgkin's lymphoma (NHL) is increasing in the United States. However, little is known about the etiology of the disease. Some studies have shown an association between gastric NHL andHelicobacter pylori.No study has specifically delineated demographic features that distinguish gastric NHL patients from nongastric NHL patients.Materials and Methods.To obtain information about the differences between gastric and nongastric NHL patients, we conducted a hospital chart review study. We examined charts of all 25 cases of primary gastric NHL, as well as charts of 75 randomly selected nongastric NHL patients as controls. All patients were seen in the Division of Oncology at Stanford University Medical Center from 1972 to 1991. Demographic information was tabulated, and differences between the cases and controls were noted. The identified risk factors were determined by both univariate and logistic regression analyses.Results.There was no difference between gastric NHL cases and nongastric controls with respect to age, gender, race, and family history of any cancer. However, in logistical regression, persons with gastric NHL were more likely than those with other forms of NHL to be born outside the United States (odds ratio = 12.8; 95% confidence interval = 2.9–56.0) and also to have a family history of stomach cancer (odds ratio = 18.4; 95% confidence interval 2.1–160.1).Conclusions.Gastric NHL is more likely than NHL at other sites to occur in persons with a family history of gastric cancer or in those born in developing countries. This epidemiological pattern supports the identified role ofH. pyloriin the development of gastric lym

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00013.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.Subsequent to the isolation ofHelicobacter pylorifrom domestic cats, it has been suggested that the organism might be transmitted from cats to humans. This hypothesis has already gained considerable media attention.Materials and Methods.In a previous study of risk factors forH. pyloriinfection, 447 factory workers from Stoke on Trent in the UK had provided blood samples forH. pyloriserological workup. They had also completed a detailed questionnaire concerning their living conditions, including the possession of any household pets, in childhood. Logistic regression was used to assess the association between cat ownership in childhood andH. pyloriseropositivity.Results.After adjustment for potential confounders, it was found that subjects who had owned a pet as a child were slightly more likely to beH. pyloriseropositive than subjects who had not. There was, however, no difference between subjects who had owned a cat and those with other pets.Results.These data do not support the hypothesis thatH. pyloriinfection might be transmitted from cats to humans.

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00014.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackground.The factors influencing the acquisition and prevalence ofHelicobacter pyloriinfection remain incompletely understood. In Russia, the demographic and socioeconomic factors are relatively similar, allowing investigation of risk factors that might not be identifiable in a more diverse population.Materials and Methods.Sero‐prevalence ofH. pyloriinfection was studied in 520 asymptomatic individuals between the ages of 1 and 75 years, residing in St. Petersburg, Russia. Forty‐four children lived in orphanages or communal apartments. Demographic information and socioeconomic factors were evaluated, including educational level, income, and living conditions.Helicobacter pyloristatus was evaluated by using an enzyme‐linked immunosorbent assay for anti‐H. pyloriIgG.Results.The prevalence ofH. pyloriinfection was 44% in children and 88% in adults (P<.001). In adults,H. pyloriprevalence was independent of socioeconomic factors. The crude and the age‐adjusted odds ratios (ORs) in children showed an inverse correlation between the mother's educational level andH. pyloriseropositivity [e.g., OR, 1.8; (95% confidence interval (CI) = 1–3.2] for children whose mothers completed only 8 to 10 years of school compared to children whose mothers completed university. Overcrowding in childhood also was associated with increasedH. pyloriprevalence. Children from orphanages and communal apartments had the highest crowding index and also were at the greatest risk forH. pyloriacquisition (age‐adjusted OR, 2.1; 95% CI = 1.2–2.5).Conclusions.The prevalence ofH. pyloriinfection in Russia correlated with socioeconomic factors, suggesting there are differences sufficient to affectH. pyloritransmission. The prevalence ofH. pyloriinfection during childhood forms the basis for the variances in prevalence am

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00015.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackgroundIsolatingHelicobacter pylorion culture media and performing antibiotic susceptibility testing is potentially the most useful tool for guiding antibiotic therapy, especially when antimicrobial resistance is suspected. The aim of this study was to determine whether the yield ofH. pyloriculture was related to the site from which the gastric specimen was obtained either before or after therapy.Methods.Gastric mucosal biopsies from the antrum and the corpus of the stomach were cultured.H. pyloristatus was determined by histological assessment using the Genta stain.Results.Fifty‐two patients with documentedH. pyloriinfection were studied: Twenty‐three were tested before antibiotic therapy and 29 after therapy had failed. In 47 patients (90%), both antral and corpus culture specimens were positive. In 5 patients (10%), only one site was positive, with three false‐negative antral and two false negative corpus cultures. The overall sensitivity of culture in detectingH. pyloriinfection was 95% (95% confidence interval = 89–98%) and was not significantly different for the antrum or corpus, either before or after therapy.Conclusion.Culture of gastric biopsies from either the antrum or the corpus has an excellent diagnostic yield even in patients who failed antimicrobial

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00016.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackgroundInfection withHelicobacter pyloricauses active chronic gastritis. Once the infection is acquired, gastritis will persist for almost the rest of one's life. To date, very few data are available onH. pylorigastritis in relation to age. Therefore, we attempted to inestigate whetherH. pylorigastritis in children exhibits features different fromH. pylorigastritis in adults of two different age groups.Materials and Methods.Fifty consecutive children with a median age of 11 years (range, 3–18 years) were compared with two groups of 50 adult patients, one group with a median age of 43 (range, 19–56 years) and another group with a median age of 70 years (range, 59–86 years). All patients hadH. pylorigastritis unrelated to active peptic ulcer disease. Two biopsy specimens were taken from the antrum and two from the corpus, and the following gastritis parameters were evaluated: degree and activity of gastritis,H. pyloricolonization, replacement of foveolar epithelium by regenerative epithelium, mucous depletion, presence of atrophic gastritis with intestinal metaplasia, and presence of lymphoid follicles.Results.Degree and activity of gastritis, extent ofH. pyloricolonization, degree of replacement by regenerative epithelium, extent of mucous depletion, degree of atrophic gastritis with intestinal metaplasia, and the presence of lymphoid follicles in the antrum, as well as the presence of lymphoid follicles in the corpus differed significantly (chi‐square test:p<.05). All these differences—except the once frequent occurrence of atrophic gastritis with intestinal metaplasia in adults—were attributable to a higher expression of these gastritis parameters in children.Conclusions.We conclude thatH. pylorigastritis, particularly in the antrum, is more severely expressed in childhood. One reason for this might be a child‐specific immune response to an infection withH. pylori.Alternatively, infection may represent a pediatric disease characterized by a nonatrophic, highly expressed form of gastritis, which changes its appearance once the host becomes adap

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00017.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackgroundHelicobacter pyloriinfection has been implicated strongly in the pathogenesis of gastritis, peptic ulcer disease, gastric adenocarcinoma, and gastric lymphoma, but the reasons for these widely different clinical outcomes are unknown. The aim of this study was to determine whether these differences could be due in part to mixed infection in the same individual, with bacteria having differences in pathogenic factors associated with ulcers.Materials and Methods.ThecagAgene ofH. pyloriwas used to test for mixed infection because it is present in only some strains, and its presence has been associated with ulcers. Polymerase chain reaction (PCR) assays for thecagAgene were applied toH. pyloriculture isolates and endoscopic gastric aspirates. Individual bacterial clones were tested for genetic similarity by random primer amplification and restriction endonuclease digestion of urease gene PCR products.Results.The majority ofH. pylori‐positive patients had stronglycagA‐positive culture isolates and endoscopic samples (62.5% and 69.6%, respectively). However, many of these patients had evidence of mixed infection withcagAnegative andcagApositive strais in cultures isolates and endoscopic samples (25% and 17.4%, respectively). Mixed infection was found to be due to genetically unrelated strains in two patients in whom genetic analysis was performed.Conclusion.Mixed infection with differences in substrain pathogenic factors might occur inH. pyloriinfection and might contribute to differences in clinical outc

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00018.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackgroundHelicobacter pyloriinfection presents as many different diseases, including asymptomatic gastritis, peptic ulcer disease, and gastric cancer. Although the virulence factor(s) responsible for differentH. pylori‐related diseases have not been identified, several candidate genes are being investigated for such an association. The polymerase chain reaction (PCR) frequently is used to assess the presence of genetic factors associated with pathogenesis of disease; thecagAgene and its product have been postulated to have a disease‐specific relationship to peptic ulcer and gastric cancer because of differential expression in these diseases compared to histological gastritis alone.Materials and Methods.Genomic DNA was amplified by PCR, using synthetic oligonucleotide primers to thecagAgene to determine the prevalence of thecagAgene in 60H. pyloriisolates obtained from well‐documented duodenal ulcer or asymptomatic gastritis patients (30 each). Results were confirmed by hybridization with a 1.4‐KbcagAprobe.Results.The expected PCR product was obtained in 90% of isolates from duodenal ulcer patients, compared to 70% of isolates from individuals with asymptomatic gastritis. The PCR products were polymorphic in size, suggestingcagAgene sequence differences among isolates. Evaluation for the presence of thecagAgene by hybridization with a 1.4‐KbcagAprobe showed a homologous product in 29 of 30 strains [96.7%; 95% confidence interval (CI) = 83–100%] from duodenal ulcer patients versus 25 of 30 strains (83.3%; 95% CI = 65–94%) obtained from individuals with asymptomatic gastritis (p= 0.19).Conclusions.The high prevalence of thecagAgene in asymptomatic gastritis suggests that it will not prove to be a useful marker to distinguish more virulent or disease‐specificH. pyloristrains. The genetic heterogeneity amongH. pyloristrains makes PCR an unwise choice as the single method to determine prevalence of a putative virulence factor. In evaluation of the prevalence of a gene or genetic factor in a population ofH. pylori, hybridization with extended probes might be important to ensure that the results are representative of the orga

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00019.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

摘要:

ABSTRACTBackgroundHelicobacter pyloriis a causative pathogen of such human stomach diseases as chronic type B gastritis, ulcer, and possibly gastric carcinoma. As a co‐factor in various redox enzymes and an essential trace metal required for the synthesis of metalloproteins, copper might play a role in the pathogenesis ofH. pylori.A gene,copA, associated with copper transport, has been isolated fromH. pyloriUA802. In this study, conservation and diversity of this gene were analyzed among someHelicobacterandCampylobacterspecies.Materials and Methods.Twenty‐one clinical isolates and strains of helicobacters and campylobacters were used in this study. Methods including polymerase chain reaction (PCR) amplification, restriction fragment‐length polymorphisms (RFLPs), and hybridization were employed to carry out this work.Results.ThecopAgene was highly conserved in all theH. pyloriisolates tested (Helicobacter nemestrinaeandHelicobacter felisbut not inHelicobacter mustelaeand theCampylobacterspecies), whereas the sequence downstream of thecopAappears to diverge amongH. pyloriisolates. In addition, two restriction patterns of the PCR‐amplifiedcopAfragments from sevenH. pyloriisolates andH. nemestrinaewere identified, and the RFLP ofH. nemestrinaewas identical to that of one of theH. pyloriisolate group.Conclusions.The adenosine triposphatase‐derived copper‐transporting mechanism is employed by variousH. pyloristrains,H. nemestrinae, H. felis, and perhaps by otherHelicobacterspecies. The nucleotide mutations have risen in thecopAgene. It appears that there is a genetic relatedness of thecopAgene toH. pyloriandH.

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00020.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY

ISSN:1083-4389    

DOI:10.1111/j.1523-5378.1996.tb00021.x

出版商:Blackwell Publishing Ltd    

年代:1996

数据来源: WILEY